The Impact of on-Site BCR-ABL Testing on the Management of CML in Ghana

BACKGROUND.

Chronic Myeloid leukaemia is characterised by the presence of the Philadelphia chromosome which contains the BCR-ABL fusion gene. Until 2007, Chronic Myeloid Leukaemia (CML) was diagnosed morphologically and managed with hydroxyurea at the Korle-Bu Teaching Hospital. Imatinib became a treatment option for patients who could afford to do molecular or cytogenetic diagnosis through GIPAP (Glivec International Patient Assistance Program) in October 2007. Samples for molecular and/or cytogenetic diagnosis had to be sent outside Ghana; this was very expensive ($300) and affordable only to a few. On-site BCR-ABL testing began in February 2013 at our centre.

AIM

To evaluate the impact of on-site testing of BCR-ABL on the management of CML at the Department of Haematology, Korle-Bu Teaching Hospital, Ghana.

METHODOLOGY

BCR-ABL test records were evaluated retrospectively over a four year period; February, 2013 to February 2017. Number of tests done annually, frequency of tests done by individual patients, results of BCR-ABL transcript levels and remission status of patients tested were obtained.

RESULTS

The cost of BCR- ABL testing became four times cheaper with on-site testing making it possible for 90% of our newly morphologically diagnosed CML patients to have their test done yearly and thus have Imatinib as a treatment option. Average number of tests done annually over the period was 126 tests. Previously only 8 could be done at an international laboratory yearly. Turnaround time for obtaining test results also reduced from 2 weeks to 2 hours. The highest transcript level obtained over the period was 160% and the lowest was 9.2% for newly diagnosed patients. Forty-eight (40%) patients have been able to repeat testing at least once after diagnosis; out of which half did at least 2 tests/year (range 2-4). Hitherto only 10 patients carried out repeat tests in order to monitor their response to treatment over a period of 5 years (2007-2012). Twenty-three (48%) patients who have repeated their tests after diagnosis have achieved major molecular response.

CONCLUSION

With the availability of on-site tests for BCR-ABL transcripts, the tests have become more affordable for patients living with CML in Ghana, the decrease in turnaround time have made initiation of treatment faster and now it is easier to assess our patients for molecular response.

Keywords: BCR-ABL, Imatinib, major molecular response

Acknowledgments

• International Chronic Myeloid Leukaemia Foundation (iCMLf)

• Cepheid

• Max Foundation

• Michael J. Mauro M.D